Telephone Helpline Research Articles

Predicting Caller Type From a Mental Health and Well-Being Helpline: Analysis of Call Log Data.

BackgroundThis paper presents an analysis of call data records pertaining to a telephone helpline in Ireland among individuals seeking mental health and well-being support and among those who are in a suicidal crisis.ObjectiveThe objective of our study was to examine whether rule sets generated from decision tree classification, trained using features derived from callers’ several initial calls, could be used to predict what caller type they would become.MethodsMachine learning techniques were applied to the call log data, and five distinct patterns of caller behaviors were revealed, each impacting the helpline capacity in different ways.ResultsThe primary findings of this study indicate that a significant model (P<.001) for predicting caller type from call log data obtained from the first 8 calls is possible. This indicates an association between callers’ behavior exhibited during initial calls and their behavior over the lifetime of using the service.ConclusionsThese data-driven findings contribute to advanced workload forecasting for operational management of the telephone-based helpline and inform the literature on helpline caller behavior in general.

Telephone Counseling for Pathological Gamblers as Immediate Access to the Health Care System: Acceptance and Use of The Mainzer Behavioral Addiction Helpline

Despite extensive psychosocial consequences, just a small number of pathological gamblers participates in counseling or treatment. Telephone helplines should facilitate pathological gamblers' access to the health care system. There is a lack of research on the use and the effects of such facilities in Germany. The present research focuses on the question whether telephone helplines facilitate pathological gamblers' access to the health care system. All first time calls due to a gambling problem received by the behavioral addiction helpline of the University Medical Center Mainz between 2013 and 2016 were analyzed by SPSS. Of the 773 calls analyzed, 89% were from male gamblers. 79.7% reported gambling in slot machine arcades as the primary problem. 66.6% received a referral for a diagnostic in-person assessment at the outpatient clinic for behavioral addiction of the University Medical Center Mainz. 80.4% made an appointment, of which 81.3% were kept. Men were more likely to keep the appointment. Only a few callers had found out about the behavioral addiction helpline by gambling providers. Telephone helplines facilitate pathological gamblers' access to the health care system.There is a deficit in the propagation of such an offer by gambling providers. Telephone helplines should be communicated more actively to problem gamblers in all gambling venues.

A methodological framework for the evaluation of syndromic surveillance systems: a case study of England

BackgroundSyndromic surveillance complements traditional public health surveillance by collecting and analysing health indicators in near real time. The rationale of syndromic surveillance is that it may detect health threats faster than traditional surveillance systems permitting more timely, and hence potentially more effective public health action. The effectiveness of syndromic surveillance largely relies on the methods used to detect aberrations. Very few studies have evaluated the performance of syndromic surveillance systems and consequently little is known about the types of events that such systems can and cannot detect.MethodsWe introduce a framework for the evaluation of syndromic surveillance systems that can be used in any setting based upon the use of simulated scenarios. For a range of scenarios this allows the time and probability of detection to be determined and uncertainty is fully incorporated. In addition, we demonstrate how such a framework can model the benefits of increases in the number of centres reporting syndromic data and also determine the minimum size of outbreaks that can or cannot be detected. Here, we demonstrate its utility using simulations of national influenza outbreaks and localised outbreaks of cryptosporidiosis.ResultsInfluenza outbreaks are consistently detected with larger outbreaks being detected in a more timely manner. Small cryptosporidiosis outbreaks (<1000 symptomatic individuals) are unlikely to be detected. We also demonstrate the advantages of having multiple syndromic data streams (e.g. emergency attendance data, telephone helpline data, general practice consultation data) as different streams are able to detect different outbreak types with different efficacy (e.g. emergency attendance data are useful for the detection of pandemic influenza but not for outbreaks of cryptosporidiosis). We also highlight that for any one disease, the utility of data streams may vary geographically, and that the detection ability of syndromic surveillance varies seasonally (e.g. an influenza outbreak starting in July is detected sooner than one starting later in the year). We argue that our framework constitutes a useful tool for public health emergency preparedness in multiple settings.ConclusionsThe proposed framework allows the exhaustive evaluation of any syndromic surveillance system and constitutes a useful tool for emergency preparedness and response.

Exploring the use of telephone helpline pertaining to older adult suicide prevention: A Hong Kong experience

BackgroundOlder adults usually have a higher suicide rate than the general population. There are helpline services provided to older adults but limited studies have examined the suicidal risks among the users, and how those services could be used as a platform to engage older adults in suicide prevention. MethodsIn regard to elderly suicide prevention, this study explored the potential usefulness and relevance of a telephone helpline service in Hong Kong, which had 106,583 users during 2012–2015. An estimation on the suicide rates of the users was made and compared with the general older adult population in Hong Kong. The users’ suicide risks and their associated factors were assessed by survival analyses and an estimation system on the users’ suicide mortality likelihood was also tested. ResultsThe suicide rates of both male and female users were more than two times higher than the general older adult population in Hong Kong. The users’ risks of suicides were greater at the early period of using the service; men, living alone, and having a history of mental illnesses were also associated with increased risks. Based on the identified factors, an estimation system was developed with a sensitivity of 0.73 and specificity of 0.54. LimitationsA secondary data analysis. ConclusionsBy identifying a suicide risk profile and distinct telephone calling pattern among the users, early detection and a warning system should be implemented to allow timely intervention to reduce the number of older adult suicides in the community.

Can a phone call make a difference? Breastfeeding self-efficacy and nurse responses to mother's calls for help.

Telephone support is a format that presents an opportunity to sustain breastfeeding at a time when mothers identify themselves as at risk of cessation. The interactive mechanisms by which support is provided have not, however, been well investigated. We aimed to identify characteristics of calls that support breastfeeding self-efficacy. Thematic analysis of 149 calls from mothers seeking help for breastfeeding made to a 24-hour parenting helpline over a four week period, in Brisbane, Australia. Call-takers were 12 qualified and experienced maternal and child health nurses. Calls classified according to changes in breastfeeding self-efficacy across the call were thematically analysed to identify distinguishing interactional characteristics. Key interactional characteristics that served to build self-efficacy were privileging the mother, teamwork and credible affirmation while those that failed to build self-efficacy were laissez-faire affirmation and pragmatic problem-solving responses. Nurse responses that undermined caller self-efficacy conceptualized breastfeeding as a problem. Telephone helplines have potential to enhance mothers' confidence and sustain breastfeeding when there is a call for help, this study highlights that the style of interaction is critical. The findings identify the need for specific training to increase awareness of interactional styles and delivery of advice through telehealth formats.

Enhancing communication skills for telehealth: development and implementation of a Teach-Back intervention for a national maternal and child health helpline in Australia

BackgroundTelehealth professionals require advanced communication skills, in part to compensate for lack of visual cues. Teach-Back is a best practice communication technique that has been recommended but not previously evaluated for consumer telehealth. We aimed to implement Teach-Back at a national maternal and child health telephone helpline. We describe the intervention and report telenurse experiences learning to use Teach-Back.MethodsWe identified barriers (time, knowledge, skills, beliefs) and enablers (self-reflection) to using Teach-Back, and developed a novel training program to address these, guided by the Theoretical Domains Framework. We engaged maternal and child health telenurses to participate in a “communication skills” study. The intervention had two key components: guided self-reflection and a Teach-Back skills workshop. For the duration of the 7-week study nurses completed brief online surveys following each call, reflecting on both the effectiveness of their communication and perceived caller understanding. At the end of each shift they reflected on what worked well. Teach-Back knowledge, skills, and beliefs were addressed in a 2-h workshop using videos, discussion, and role play. We explored nurses’ experiences of the intervention in focus groups and interviews; and analysed transcripts and comments from the self-reflection surveys using the Framework method. This study forms part of a larger evaluation conducted in 2016.ResultsIn total 16 nurses participated: 15 were trained in Teach-Back, and 13 participated in focus groups or interviews. All engaged with both self-reflection and Teach-Back, although to differing extents. Those who reported acquiring Teach-Back skills easily limited themselves to one or two Teach-Back phrases. Nurses reported that actively self-reflecting (including on what they did well) was useful both for developing Teach-Back skills and analysing effectiveness of the techniques. Most wanted more opportunity to learn how their colleagues manage Teach-Back in different situations, and more visual reminders to use Teach-Back.ConclusionsOur theory-informed intervention successfully enabled nurses to use Teach-Back. Guided self-reflection is a low-resource method aligned with nurse professional identity that can facilitate Teach-Back skills learning, and could also be applied to other advanced communication skills for telehealth. Listening to multiple workplace-specific examples of Teach-Back is recommended for future training.Trial registrationACTRN12616000623493 Registered 15 May 2016. Retrospectively registered.

MHealth: Knowledge and use among doctors and nurses in public secondary health-care facilities of Lagos, Nigeria

Objectives: Mobile health (mHealth) is gaining importance worldwide, changing and improving the way healthcare and services are provided, but its role is just emerging in Nigeria. This study aimed to assess the knowledge and use of mHealth among health workers and the provisions for its use in public secondary health-care facilities of Lagos State, Nigeria. Methods: The study was a descriptive cross-sectional study carried out among 65 doctors and 135 nurses selected using a two-staged sampling method. Data were collected with pretested self-administered questionnaires and analyzed with EpiInfo™ 7. Results: Majority (doctors 84.6%, nurses 91.1%) had not heard of the term “mHealth,” but most (doctors 96.9%, nurses 87.4%) were aware of the use of mobile phones in health-care delivery. Only three (27.3%) (health call centers/health-care telephone helpline, appointment reminders, and mobile telemedicine) out of 11 mHealth components listed were mostly known. Most doctors simply used patient monitoring/surveillance and mobile telemedicine, while nurses mainly used treatment compliance and appointment reminder services. Majority were willing to use more mHealth services if available in their hospital. All the doctors and 97% of nurses had mobile phones. However, only about one-quarter (27.5%) had smartphones with applications used for mHealth purposes. Conclusions: Knowledge, awareness, and use of mHealth services were low. Doctors and nurses should be enlightened and trained on ways to use mHealth services to improve health-care delivery, mHealth services should be made available in the hospitals, and use of smartphones encouraged as they portend better adaptability for mHealth use.

Telephone helplines as a source of support for eating disorders: Service user, carer, and health professional perspectives

ABSTRACTAccess to care for eating disorders can be problematic for numerous reasons including lack of understanding and delays with treatment referrals. Previous research has highlighted the benefits of telephone helplines as an accessible source of support for those who may not wish to access face-to-face support or to fill a gap for those waiting for treatment. This study aimed to gain an insight into the perspectives of those who may use or refer others to a telephone helpline in order to identify the requirements of such a service. Triangulation of service user, carer and health professionals’ perspectives resulted in identification of themes relating to the type of support, delivery and practicalities of a helpline. The findings indicated that telephone helplines may offer numerous benefits for individuals with an eating disorder, whether accessed as a first step, alongside treatment or as an extension of this support when in recovery. Additionally helplines may provide an opportunity for carers to access information and discuss their own experiences, while supporting their loved one. Raising awareness of these services is important to encourage those affected by an eating disorder to access and make the most of this type of support. These findings offer an insight into the key requirements for new and existing service development with regard to both the type of support and the method of communication required by individuals with eating disorders.

Achieving positive outcomes in complex cases: The Admiral Nurse Dementia Helpline (Innovative Practice).

Carer distress is an all too common factor in caring for someone with dementia, whether living with the person with dementia, or trying to maintain their independence when they are living alone. Providing support for families on many day-to-day issues with immediacy as and when they arise can be very difficult to achieve for services on the ground as carer need can be difficult to anticipate as well as the changing status of the person with dementia. This paper discusses the innovative role of managing complexity on a dementia telephone helpline manned by Admiral Nurses, specialist dementia nurses, in expertly supporting a family over a weekend where there were health concerns of a family member with dementia and a high level of carer distress.

Using the eSexual Health Clinic to access chlamydia treatment and care via the internet: a qualitative interview study

ObjectiveWe developed the eSexual Health Clinic (eSHC), an innovative, complex clinical and public health intervention, embedded within a specialist sexual health service. Patients with genital chlamydia access their results online...

Collaboration between a child telephone helpline and sexual and reproductive health and rights organisations in Senegal: lessons learned

This study identifies lessons learned from a collaboration between a child telephone helpline and sexual and reproductive health and rights (SRHR) organisations in Senegal established in the context of an SRHR programme for young people. We assessed how helpline operators are equipped to address sexual health and rights issues with young people, what the relevant skills of operators are, and to what extent referral to sexual and reproductive health (SRH) service providers took place. A documentary review, a vignette study and interviews with six key informants and all seven operators took place. The collaboration led to promising initiatives, such as the provision of SRH training, the exchange of staff, referral to SRH service providers. However, the counselling advice provided by operators was not always in line with the rights-based approach and responses were influenced by underlying norms concerning young people’s sexuality. Additionally, concerns about confidentiality were noted. The collaboration was an innovative attempt to respond to young people’s limited access to SRHR information and services but there is a need for more in-depth training of helpline operator’s skills and the development of a standardised rights-based counselling manual.

Uptake of mental health websites in primary care: Insights from an Australian longitudinal cohort study of depression

ObjectiveTo describe the characteristics of primary care attendees with depressive symptoms who use mental health websites. Methods789 individuals with depressive symptoms recruited and followed up annually for nine years. Self-reported written surveys included mental health, professional and self-help use, e-mental health interventions or therapeutic websites. Marginal logistic regression examined association between mental health website (MHW) use and patient’s mental health, health services use, anti-depressant use and self-help strategies. Results36% of participants used an MHW at least once. MHW users were more likely to be female, younger, highly educated and employed. MHW use increased with depressive symptom severity; reported in 16% of assessments when minimal symptoms were present and 28% when severe symptoms were present. MHW use was associated with: GP mental health visits, psychologist and psychiatrist visits and other self-help strategies including self-help books and telephone helplines. Conclusion(s)Mental health websites were more likely to be used by those with severe depressive symptoms rather than those with mild depression as recommended in current guidelines. Practice implication(s)Whilst mental health websites offer potential to support the high volume of people with mild depression new strategies may be required to ensure uptake.

Comparing counselling models for the hazardous use of alcohol at the Swedish National Alcohol Helpline: study protocol for a randomised controlled trial

BackgroundHazardous and harmful consumption of alcohol is a leading cause of preventable disease and premature deaths. Modifying the amount and pattern of risky alcohol consumption conveys substantial benefits to individuals and to society at large. Telephone helplines provide a feasible alternative to face-to-face counselling in order to increase the reach of brief interventions aiming at modifying the hazardous and harmful use of alcohol. However, there is a lack of studies on the implementation and evaluation of population-based telephone services for the prevention and treatment of alcohol misuse.Methods/designA randomised controlled trial was designed to compare a brief, structured intervention to usual care within the Swedish National Alcohol Helpline (SAH), concerning their effectiveness on decreasing the hazardous use of alcohol. Between May 2015 and December 2017, about 300 callers are to be individually randomised with a 1:1 ratio to a brief, structured intervention (n = 150) or to usual care (n = 150). The brief, structured intervention consists of the delivery of a self-help booklet followed by one proactive call from SAH counsellors to monitor and give feedback about the client’s progression. Callers assigned to usual care receive telephone counselling according to existing practice, i.e., motivational interviewing in a tailored and client-driven combination of proactive and reactive calls. The primary outcome is defined as a change from a higher to a lower AUDIT risk-level category between baseline and follow-up. General linear modeling will be used to calculate risk ratios of the outcome events. The primary analysis will follow an intention-to-treat (ITT) approach.DiscussionThe trial is designed to evaluate the effectiveness in decreasing the hazardous and harmful consumption of alcohol of a brief, structured intervention compared to usual care when delivered at the SAH. The results of the study will be used locally to improve the effectiveness of the service provided at the SAH. Additionally, they will expand the evidence base about optimal counselling models in population-based telephone services for alcohol misuse prevention and treatment.Trial registrationISRCNT.com, ID: ISRCTN13160878. Retrospectively registered on 18 January 2016.

Delivering healthcare at a distance: Exploring the organisation of calls to a health helpline

BackgroundHealth helplines are integral to contemporary healthcare, offering fast, low-cost, and geographically unrestricted access to health information and advice. Although some health helplines offer support services (e.g., counselling), many function in ways that are similar to physically co-present (i.e., face-to-face) primary care consultations. However, due to the lack of physical presence, there are differences in the way health consultations are routinely managed on the telephone. This article explores some ways in which healthcare is managed at a distance, on a telephone helpline. MethodsData are 196 recorded calls from the helpline, Healthdirect Australia. Using conversation analysis, this paper compares the delivery of healthcare over the telephone with what is known about physically co-present primary care consultations. ResultsThrough an exploration of the overall structure of these helpline calls, we show how Healthdirect Australia calls are organised in terms of eight distinct phases: call opening, establishment of reason-for-calling, check of caller safety, creation of a confidential patient file, medical information-gathering, health advice, caller survey questions, and call closing. We demonstrate how interactants organise their talk around these phases, with a particular focus on the shift between mandated administrative tasks and traditional medical tasks. ConclusionsFindings from this study suggest that there are systematic differences between the overall structure of health helplines and physically co-present primary care consultations. We demonstrate that the delivery of health information and advice via helplines can be challenging, but that service can be enhanced through continued efforts to inform understanding about how medical encounters routinely unfold in over-the-phone environments.

Interpreting specific and general respiratory indicators in syndromic surveillance

ObjectiveTo improve understanding of the relative burden of differentcausative respiratory pathogens on respiratory syndromic indicatorsmonitored using syndromic surveillance systems in England.IntroductionPublic Health England (PHE) uses syndromic surveillance systemsto monitor for seasonal increases in respiratory illness. Respiratoryillnesses create a considerable burden on health care services andtherefore identifying the timing and intensity of peaks of activity isimportant for public health decision-making. Furthermore, identifyingthe incidence of specific respiratory pathogens circulating in thecommunity is essential for targeting public health interventionse.g. vaccination. Syndromic surveillance can provide early warningof increases, but cannot explicitly identify the pathogens responsiblefor such increases.PHE uses a range of general and specific respiratory syndromicindicators in their syndromic surveillance systems, e.g. “allrespiratory disease”, “influenza-like illness”, “bronchitis” and“cough”. Previous research has shown that “influenza-like illness”is associated with influenza circulating in the community1whilst“cough” and “bronchitis” syndromic indicators in children under 5are associated with respiratory syncytial virus (RSV)2, 3. However, therelative burden of other pathogens, e.g. rhinovirus and parainfluenzais less well understood. We have sought to further understand therelationship between specific pathogens and syndromic indicators andto improve estimates of disease burden. Therefore, we modelled theassociation between pathogen incidence, using laboratory reports andhealth care presentations, using syndromic data.MethodsWe used positive laboratory reports for the following pathogens as aproxy for community incidence in England: human metapneumovirus(HMPV), RSV, coronavirus, influenza strains, invasivehaemophilusinfluenzae, invasivestreptococcus pneumoniae, mycoplasmapneumoniae, parainfluenza and rhinovirus. Organisms were chosenthat were found to be important in previous work2and were availablefrom routine laboratory testing. Syndromic data included consultationswith family doctors (called General Practitioners or GPs), calls to anational telephone helpline “NHS 111” and attendances at emergencydepartments (EDs). Associations between laboratory reports andsyndromic data were examined over four winter seasons (weeks40 to 20), between 2011 and 2015. Multiple linear regression was usedto model correlations and to estimate the proportion of syndromicconsultations associated with specific pathogens. Finally, burdenestimates were used to infer the proportion of patients affected byspecific pathogens that would be diagnosed with different symptoms.ResultsInfluenza and RSV exhibited the greatest seasonal variation andwere responsible for the strongest associated burden on generalrespiratory infections. However, associations were found with theother pathogens and the burden ofstreptococcus pneumoniaewasimportant in adult age groups (25 years and over).The model estimates suggested that only a small proportion ofpatients with influenza receive a specific diagnosis that is coded toan “influenza-like illness” syndromic indicator, (6% for both GPin-hours consultations and for emergency department attendances),compared to a more general respiratory diagnosis. Also, patients withinfluenza calling NHS 111 were more likely to receive a diagnosisof fever or cough than cold/flu. Despite these findings, the specificsyndromic indicators remained more sensitive to changes in influenzaincidence than the general indicators.ConclusionsThe majority of patients affected by a seasonal respiratory pathogenare likely to receive a non-specific respiratory diagnosis. Therefore,estimates of community burden using more specific syndromicindicators such as “influenza-like illness” are likely to be a severeunderestimate. However, these specific indicators remain importantfor detecting changes in incidence and providing added intelligenceon likely causative pathogens.Specific syndromic indicators were associated with multiplepathogens and we were unable to identify indicators that were goodmarkers for pathogens other than influenza or RSV. However, futurework focusing on differences between ages and the relative levels ofa range of pathogens may be able to provide estimates for the mix ofpathogens present in the community in real-time.

Emergency department attendance after telephone triage

ABSTRACTObjectivesTo measure compliance with telephone helpline advice to attend an emergency department (ED) and the acuity of patients who presented to ED following a call. ApproachPopulation based, observational cohort study of all calls (n=1.04 million) to the healthdirect helpline over four years made by residents of New South Wales (NSW), Australia, linked to records of ED presentations, hospital admissions and death registrations using probabilistic data linkage. Outcomes measured include: compliance with dispositions to attend an ED, self-referral to ED by patients given low urgency dispositions, predictors of compliance and self-referral, and triage levels at ED presentation. This helpline dataset had not been previously linked with clinical outcome data, and this is the largest population-based linkage of telephone triage data conducted internationally.Results67.2% of patients were compliant with dispositions to attend an ED and the great majority of these (95.2%) attended within four hours of the call. Compliance was highest in patients aged 10-14 years, in residents of major cities and inner regional areas, in middle socio-economic quintiles, in calls triaged after-hours by nurses, in patients who had not been frequent callers to the service, and in callers with an original intention matching the disposition. In patients receiving a low-urgency disposition, 6.2% attended ED within 24 hours of the call (50.4% of these within four hours). Predictors of self-referral included older patient age, and calls triaged after hours. Calls from remote areas and areas in high socio-economic quintiles and where the original intention was similar to the disposition, were less likely to self-refer to ED. After age-adjustment, healthdirect compliant patients who attended ED were significantly less likely (7.7%) to receive the least urgent triage category (Australasian Triage Scale [ATS] 5) compared to the general NSW ED population (16.9%). Compliant healthdirect ED attenders also included a significantly higher proportion of patients triaged as the more urgent ATS 3 (37.0%) compared to the general NSW population (30.0%).Conversely, patients who self-referred to the ED did not differ significantly from the general population in allocation to lower urgency categories. ConclusionThis large population-based data linkage study provides precise estimates of ED attendance following calls to a telephone triage service, and details the predictors of ED attendance. The findings with regard to triage categories at ED presentation indicate that the healthdirect helpline is not referring substantial numbers of low-urgency patients to EDs.

Emergency Department Attendance after Telephone Triage: A Population-Based Data Linkage Study.

To investigate compliance with telephone helpline advice to attend an emergency department (ED) and the acuity of patients who presented to ED following a call. In New South Wales (NSW), Australia, 2009-2012, all (1.04 million) calls to a telephone triage service, ED presentations, hospital admissions and death registrations, linked using probabilistic data linkage. Population-based, observational cohort study measuring ED presentations within 24hours of a call in patients (1) with dispositions to attend ED (compliance) and (2) low-urgency dispositions (self-referral), triage categories on ED presentation. A total of 66.5 percent of patients were compliant with dispositions to attend an ED. A total of 6.2 percent of patients with low-urgency dispositions self-referred to the ED within 24hours. After age adjustment, healthdirect compliant patients were significantly less likely (7.8 percent) to receive the least urgent ED triage category compared to the general NSW ED population (16.9 percent). This large population-based data linkage study provides precise estimates of ED attendance following calls to a telephone triage service and details the predictors of ED attendance. Patients who attend an ED compliant with a healthdirect helpline disposition are significantly less likely than the general ED population to receive the lowest urgency triage category on arrival.

Advance Decisions: issues of autonomy, identity and efficacy

PurposeThe purpose of this paper is to introduce Advance Decisions, address low uptake and examine fundamental issues that can inform the development of policy and practice in this area.Design/methodology/approachThis paper discusses findings from a research project with the charity Compassion in Dying (analysing calls to its telephone helpline) and practical experience of working with the charity Advance Decisions Assistance (helping people write Advance Decisions and training healthcare professionals).FindingsOlder people themselves identify the issues of autonomy, identity and efficacy as key challenges in writing Advance Decisions and having them respected.Originality/valueThis paper shows how addressing the “real world” challenges of advance decision making can inform policy and practice.

Preferences for Disease-Related Education and Support Among Younger People With Hip or Knee Osteoarthritis.

To explore the usefulness and accessibility of different delivery modes of disease-related education and support, as perceived by younger people with osteoarthritis (OA). People ages 20-55 years with hip or knee OA were recruited from 3 major Australian public hospitals and the community (n = 147). Data were collected on use of disease-related education and support services, as well as perceived usefulness and accessibility of delivery modes including group-based programs, online resources, telephone helplines, mailed information, social media, and mobile applications (rated on visual analog scales from 1-10; higher scores indicate greater usefulness or accessibility). Very few participants had used social media (5%), group self-management programs (3%), or telephone helplines (2%) to obtain OA information. Mailed information packs and online education programs were considered the most useful (median usefulness scores 8.0 and 7.0, respectively) and accessible methods (median accessibility scores 10.0 and 9.0, respectively) for providing OA education and support. Social media was perceived as least useful (median usefulness score 2.0) and least accessible; 45% of participants considered it "not at all useful," while 35% reported it would be "very difficult" to access OA education and support by this means. Less educational attainment was associated with greater perceived difficulty in accessing online/electronic delivery modes, while people in paid work perceived easier access. These data highlight the value of mailed information and online education to younger people with OA and can be used to develop targeted resources for individuals of working age. Social media was not a highly valued source of disease-related education and support.

Prevention of suicide

Suicide is a major public health problem in India, probably even bigger than in the West. Suicidal behavior is the best conceptualized as a multifaceted complex problem involving social factors and mental illnesses. Broadly, there are two approaches to suicide prevention; population preventive strategies and high-risk preventive strategies. Population preventive strategies include reducing availability of means for suicide, education of primary care physicians, influencing media portrayal of suicidal behavior, education of the public, telephone helplines, and addressing economic issues associated with suicidal behavior. High-risk preventive strategy includes identifying individuals with high risk of committing suicide, intensively treating mental illness if present, and providing psychosocial support. Thus, prevention requires a multipronged effort with collaboration from various sectors including mental health professionals, social justice department, and macroeconomic policy makers.